An 8-week program of mindfulness training to enhance self-management among people with chronic illnesses such as diabetes and arthritis, a study has found. The researchers used rates of initiation of health behavior action plans to measure improvement in the patients' self-management skills.
The insurance-reimbursable intervention was associated with higher rates of action-plan initiation than those seen in people exposed to a low-dose comparator (LDC) consisting of a 60-minute introduction to mindfulness, digital and community resources, and standard mental health care. The study was published online in the Journal of General Internal Medicine.
Mindfulness Training for Primary Care
The program, called Mindfulness Training for Primary Care (MTPC), "was more effective for improving emotion regulation, interoceptive awareness, self-compassion, and mindfulness at 8 weeks" compared with the low-dose approach, the explain.
The study's primary outcome was the impact of the MTPC program compared to that of the LDC in patients' initiation of an action plan within 2 weeks of setting a goal for health behavior self-management. Secondary outcomes included changes in levels of anxiety, depression, and stress 8 and 24 weeks after the intervention, compared with baseline.
The MTPC consisted of eight weekly 2-hour sessions, co-led by two trained providers, one 7-hour session, and a recommendation for 30 to 45 minutes of daily practice at home, using guided recordings. Patients in the LDC group were encouraged to use the mindfulness techniques demonstrated in the 60-minute introduction and to supplement that with digital and community resources, while continuing their standard mental health care.
During week 7, all participants were instructed to create a short-term action plan related to health maintenance or self-management of a chronic disease. At weeks 8 and 9, they completed an action plan initiation (API) that measured the degree to which they had started the plan. Scores on the survey ranged from 1 (not at all) to 7 (completely). "Evidence of plan initiation was defined as an API score ≥5," the authors write.
The final analysis included 92 patients in the MTPC group, of whom 68 developed an action plan, and 44 in the LDC group, of whom 33 developed an action plan. Fifty-three patients (77.9%) in the MTPC group reported initiation of the action plan, compared with 14 patients (42.4%) in the LDC group (odds ratio [OR], 2.91; P = .006). Of the 101 participants who responded to the API survey, MTPC was associated with higher API rates (OR, 4.8, P = .001).
The authors also found large within-group effect sizes with MTPC for anxiety, mindfulness, self-compassion, and interoceptive awareness at 8 and 24 weeks, and for emotional regulation at 24 weeks. They observed moderate to large within-group effect sizes associated with MTPC for depression and stress at 8 and 24 weeks, but also within the LDC group for self-compassion and stress at 8 and 24 weeks, along with anxiety and depression at 24 weeks.
Mindfulness-based programs "are evidence-based treatments that seem to harness self-regulatory mechanisms and could help people with self-regulation challenges catalyze behavior change related to managing chronic disease," the authors say.
The findings suggest that "integrating MTPC into the health care system as an insurance-reimbursable, referral-based treatment is effective in facilitating health behavior change for primary care patients with a variety of chronic conditions," the authors concludes. The program "facilitates self-management of chronic disease and represents a compelling model for dissemination within primary care patient-centered medical homes."
Study limitations include variations in the mental health care received by patients in the control group, which limited the conclusions that could be drawn about their outcomes, and use of self-assessments when measuring patients' initiation of their action plans.